Diabetes, Prediabetes, and Metabolic Syndrome Among People Living with HIV

With HIV now a chronic disease, other chronic diseases associated with aging are on the rise in people living with HIV (PLWH), including diabetes mellitus (DM). DM in PLWH is associated with traditional risk factors, like age, sex, race, and BMI, and the additional interplay of HIV and antiretroviral therapy. The incidence of DM in PLWH is higher than that of the general population making regular screening for DM in PLWH necessary. However, the means of screening for DM in the general population using hemoglobin A1c may not adequately identify DM or prediabetes in PLWH, leaving traditional glucose monitoring as the best means of screening for altered glucose metabolism. The effective management of DM among this specific population needs a thorough understanding of pathophysiology and pharmacotherapy. Current strategies to decrease cardio-metabolic risks in PLWH mirror those in the general population, with main focus on treatment of modifiable risk factors. Decisions regarding the choice of medications for DM should be individualized, taking into account other comorbidities. Newer medications show promise for benefit outside of glucose control, but studies in PLWH specifically are not available. A multidisciplinary approach would be beneficial for the evaluation and management of DM, prediabetes, and metabolic syndrome in this subset of population.